Zhou Joanne, Butler Erin E, Rose Jessica
Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA.
Thayer School of Engineering, Dartmouth CollegeHanover, NH, USA; Neukom Institute for Computational Sciences, Dartmouth CollegeHanover, NH, USA.
Front Hum Neurosci. 2017 Mar 17;11:103. doi: 10.3389/fnhum.2017.00103. eCollection 2017.
Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.
脑瘫（CP）是儿童中最常见的运动障碍。脑瘫的诊断通常基于异常的肌张力或姿势、运动发育里程碑的延迟，或幼儿步态异常的存在。对高危新生儿和被诊断为脑瘫的儿童进行神经影像学检查，已确定了与脑瘫相关的神经损伤模式，然而，常见步态异常的神经基础在很大程度上仍未得到充分描述。在此，我们综述了脑瘫中脑损伤的性质，以及脑瘫患儿常见的神经肌肉缺陷和随后的步态异常。我们首先从早产和足月产儿童产前、围产期或产后的损伤机制、模式和时间方面讨论脑损伤。其次，我们概述脑瘫的神经肌肉缺陷，重点是痉挛型脑瘫，其在微观和功能水平上的特征为肌肉无力、肌腱单位缩短、痉挛和选择性运动控制受损。第三，我们研究神经肌肉缺陷对脑瘫步态异常的影响，同时考虑关于步态异常神经关联的新信息及其对策略性治疗的影响。这篇关于脑瘫步态异常神经基础的综述讨论了脑损伤的位置和程度与脑瘫类型和严重程度之间的已知联系，以及相关的神经肌肉缺陷和随后的步态异常。确定了有针对性的治疗机会，这些机会可能改善脑瘫患儿的功能结局。通过提供关于脑瘫步态异常神经基础的这一背景信息，我们希望突出可减少脑瘫长期致残影响的进一步研究领域。
